Sax Paul E, Sypek Alexis, Berkowitz Bethany K, Morris Bethany L, Losina Elena, Paltiel A David, Kelly Kathleen A, Seage George R, Walensky Rochelle P, Weinstein Milton C, Eron Joseph, Freedberg Kenneth A
Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, United States of America; Harvard University Center for AIDS Research, Harvard University, Boston, Massachusetts, United States of America.
Division of General Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America; Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America.
PLoS One. 2014 Nov 14;9(11):e113031. doi: 10.1371/journal.pone.0113031. eCollection 2014.
We examined efficacy, toxicity, relapse, cost, and quality-of-life thresholds of hypothetical HIV cure interventions that would make them cost-effective compared to life-long antiretroviral therapy (ART).
We used a computer simulation model to assess three HIV cure strategies: Gene Therapy, Chemotherapy, and Stem Cell Transplantation (SCT), each compared to ART. Efficacy and cost parameters were varied widely in sensitivity analysis. Outcomes included quality-adjusted life expectancy, lifetime cost, and cost-effectiveness in dollars/quality-adjusted life year ($/QALY) gained. Strategies were deemed cost-effective with incremental cost-effectiveness ratios <$100,000/QALY.
For patients on ART, discounted quality-adjusted life expectancy was 16.4 years and lifetime costs were $591,400. Gene Therapy was cost-effective with efficacy of 10%, relapse rate 0.5%/month, and cost $54,000. Chemotherapy was cost-effective with efficacy of 88%, relapse rate 0.5%/month, and cost $12,400/month for 24 months. At $150,000/procedure, SCT was cost-effective with efficacy of 79% and relapse rate 0.5%/month. Moderate efficacy increases and cost reductions made Gene Therapy cost-saving, but substantial efficacy/cost changes were needed to make Chemotherapy or SCT cost-saving.
Depending on efficacy, relapse rate, and cost, cure strategies could be cost-effective compared to current ART and potentially cost-saving. These results may help provide performance targets for developing cure strategies for HIV.
我们研究了假设的艾滋病治愈干预措施的疗效、毒性、复发情况、成本和生活质量阈值，这些干预措施与终身抗逆转录病毒疗法（ART）相比，将具有成本效益。
我们使用计算机模拟模型评估三种艾滋病治愈策略：基因疗法、化学疗法和干细胞移植（SCT），并将每种策略与ART进行比较。在敏感性分析中，疗效和成本参数有很大变化。结果包括质量调整生命预期、终身成本以及每获得一个质量调整生命年（$/QALY）的成本效益。当增量成本效益比<$100,000/QALY时，策略被认为具有成本效益。
对于接受ART治疗的患者，贴现后的质量调整生命预期为16.4年，终身成本为591,400美元。基因疗法具有成本效益，疗效为10%，复发率为0.5%/月，成本为54,000美元。化学疗法具有成本效益，疗效为88%，复发率为0.5%/月，24个月的成本为每月12,400美元。干细胞移植每次手术费用为150,000美元时，疗效为79%，复发率为0.5%/月，具有成本效益。适度提高疗效和降低成本使基因疗法节省成本，但需要大幅改变疗效/成本才能使化学疗法或干细胞移植节省成本。
根据疗效、复发率和成本，与目前ART相比，治愈策略可能具有成本效益，甚至可能节省成本。这些结果可能有助于为开发艾滋病治愈策略提供性能目标。
